Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care.

Kuldeep N. Yadav is a research coordinator in the Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.

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Nicole B. Gabler is a senior research investigator in the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania.

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Elizabeth Cooney is director of research operations of the Palliative and Advanced Illness Research Center and assistant director of the Fostering Improvement in End-of-Life Decision Science Program, Perelman School of Medicine, University of Pennsylvania.

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Saida Kent is a medical student at the University of Kentucky College of Medicine, in Lexington, and a research assistant in the Palliative and Advanced Illness Research Center, University of Pennsylvania.

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Jennifer Kim is a medical student at Thomas Jefferson University, in Philadelphia.

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Nicole Herbst is a medical resident at Boston Medical Center, in Massachusetts.

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Adjoa Mante is an undergraduate student at Princeton University, in New Jersey.

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Scott D. Halpern is director of the Palliative and Advanced Illness Research Center, director of the Fostering Improvement in End-of-Life Decision Science Program, and an associate professor of medicine, epidemiology, and medical ethics and health policy, all at the Perelman School of Medicine, University of Pennsylvania.

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Katherine R. Courtright (katherine.courtright@uphs.upenn.edu) is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care, the Palliative and Advanced Illness Research Center, and the Fostering Improvement in End-of-Life Decision Science Program, all at the Perelman School of Medicine, University of Pennsylvania.

Abstract

Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people's preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011-16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an advance directive, including 29.3 percent with living wills. These proportions were similar across the years reviewed. Similar proportions of patients with chronic illnesses (38.2 percent) and healthy adults (32.7 percent) had completed advance directives. The findings provide benchmarks for gauging future policies and practices designed to motivate completion of advance directives, particularly among those people most likely to benefit from having these documents on record.

Project HOPE—The People-to-People Health Foundation, Inc.

KEYWORDS:

advance care planning; advance directive; end of life; healthcare proxy; living will